Many of us devote time to a skincare routine in hopes of delaying signs of aging, but taking care of our hair is equally as important to help prevent hair loss and thinning, which can happen to anyone. „Most people think hair loss is a medical problem only impacting men. The truth is women make up about forty (40) percent of hair loss patients. According to the American Academy of Dermatology, it’s an increasingly recognizable aesthetic concern, affecting thirty (30) million women in the United States. More importantly, female pattern hair loss needs to be recognized as a chronic and progressive condition. All treatments need to be continued to maintain the effect,“ Dr. Ken L. Williams Jr., D.O., FISHRS, ABHRS, surgeon and founder of Orange County Hair Restoration in Irvine, CA, and author of Hair Transplant 360 – Follicular Unit Extraction tells Eat This, Not That! In many cases, treatment and preventive measures can help reverse hair loss, so if you’ve been noticing more strands of hair on your pillow or in your brush, don’t panic. Dr. Williams explained to us what to know about hair loss and revealed effective treatments that work. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.
Dr. Williams suggests to, „Consider a proactive role in keeping your hair youthful looking by:
–Improving nutritional status and adding vitamin supplementation to your daily lifestyle. Hair specific vitamin products include Viviscal™
–Keep your weight near ideal levels, exercise regularly, avoid the sun, and importantly reduce the stress in your life
–Individuals who are genetically inclined to progress to male and female pattern balding need to be under the care of a hair restoration surgeon and take Minoxidil and Finasteride at early ages
–Consider adding a Low Laser Light device such as Capillus™ to your daily routine.“
According to WebMD, some women take spironolactone to treat hair loss, but it’s not recommended for everyone. WebMD states, „It can cause high levels of potassium to build up in the body, so it’s not the first thing a doctor would use for hair loss,“ and in addition, „spironolactone can cause birth defects in male children. Women of childbearing age either shouldn’t take it or must use birth control when using this medication.“
Dr. Williams adds, „Spironolactone or Aldactone is in a class of drugs called potassium-sparing diuretics (water pill). It is used to reduce the amount of fluid in your body without causing the loss of potassium. It is also used to treat hypertension (high blood pressure) and edema (swelling) and used to treat potassium deficiency and hyperaldosteronism (a hormonal disorder). Spironolactone is an anti-androgen that works by primarily decreasing the production of androgens in the adrenal glands and ovaries. Secondly it blocks the action of androgens in part by preventing Dihydrotestosterone (DHT) from binding to its Androgenetic receptor.“
Dr. Willams explains, „Cimetidine or Tagamet belongs to a class of H2 blockers used to treat gastrointestinal ulcers. The histamine blocking action prevents the stomach from producing excess acid, allowing the body to heal the ulcer. Cimetidine also has a fairly powerful anti-androgenic effect and has shown to block DHT from binding the follicle receptor sites. Cimetidine has been used to treat hyperandrogenic conditions like Hirsutism in women (excess facial hair growth), and has been studied in women with Androgenic Alopecia showing promising results. Because of the high doses needed to achieve its hair raising results, men should not take Cimetidine to treat their hair loss due to possible feminizing effects including adverse sexual side effects.“
„Also known as hormone replacement therapy (HRT) and commonly prescribed at menopause, estrogen and progesterone pills and creams are probably the most common systemic form of treatment for Androgenetic Alopecia for women in menopause or whose estrogen and/or progesterone are lacking for other reasons,“ says Dr. Williams.
„Oral contraceptives can be used to treat hair loss in women,“ Dr. Williams states. „It is important to remember, though, precautions must be followed by female patients because contraceptive pills solely to treat female pattern baldness does carry a risk. For example, smokers over thirty-five who take OC’s are at higher risk for blood clots and other serious conditions. This is the reason why a thorough physical evaluation and hormone evaluation is important before you begin treatment. If you use OC’s, only use low androgen index birth control pills. High androgen index birth control pills contribute to hair loss by triggering it or enabling it.“
Dr. Williams shares, „Available as a topical treatment by prescription, Nizoral or its generic form Ketoconazole, is used as an antifungal agent but its anti-androgenic effects reduce the production of testosterone and other androgens by the adrenal gland and by the male and female reproductive organs. Ketoconazole has been seen to cause 5 -reductase inhibition. Additionally, in humans Ketoconazole has also been shown to inhibit the binding of 5 -reductase to sex hormone globulins. Clinical studies suggest that Ketoconazole may inhibit the production of DHT thus reducing the pathway that leads to the characteristic miniaturization of hair follicles in Androgenetic Alopecia. In the case of Androgenetic Alopecia treatment, the only tissue that requires a relatively high concentration of Ketoconazole is the hair follicles, and local application of Ketoconazole in the form of a shampoo is the best way to administer treatment. Topical administration avoids systemic toxicity and the agent can be directly delivered to the affected area.“
Dr. Williams shares, „Finasteride is the generic name for Propecia/Proscar. This medication was originally made to treat prostate disease. It works primarily by inhibiting an enzyme that harms the hair follicle. This enzyme is called 5-alpha reductase. It is well known that testosterone is converted to Dihydrotestosterone (DHT) in the Dermal Papillae region of the hair follicle. It is the DHT that inhibits the normal growth cycles of the hair follicle. Finasteride is a prescription medication often used for men, but it can be used in women who have Polycystic Ovarian Disease and Hirsutism caused by elevated androgen levels. Finasteride is not recommended for women primarily because it is often associated with some birth defects if the patient is in their child bearing years. For women in child bearing years two forms of contraception are necessary if this medication is going to be used. Recent studies have shown Oral Finasteride at a dosage of 2.5 mg may be effective in treating women. The length of a person’s hair is determined by numerous factors. They include genetics, general health and well-being, stress, environmental, nutritional, and in men a hormone called Dihydrotestosterone (DHT). Younger individuals tend to have a higher quality and quantity of hair volume or density. Older individuals (over 40 years) just don’t have the same regenerative and physiologic capacity that younger people possess. As a consequence of the aging process, the loss of collagen and many proteins leads to a lesser quality of the skin/scalp and hair density, volume and appearance.“
Dr. Williams says, „Hair loss can be a very emotionally difficult event because hair has an important psychological importance in our society. Most men experience some degree of hair loss in their lifetime which can start as early in some men in their early twenties. Androgenetic Alopecia (AA) or common male pattern baldness (MPB) accounts for more than 95% of hair loss in men. By the age of thirty-five (35) over 60% of American men will experience some degree of appreciable hair loss, and by the age of fifty (50) approximately 85% of men have significantly thinning hair. Hair follicles perpetually go through three different stages. The normal cycle of hair growth lasts for 2 to 6 years. This stage is called the Anagen stage. During this stage hair will grow approximately one (1) centimeter (less than half an inch) per month. About 90 percent of the hair on your scalp is growing at any one time. About 10 percent of the hair on your scalp is in the involution phase, also called the Catagen phase which lasts about 2 weeks. The hair then enters the Telogen or resting phase for 2 to 3 months. At the end of the resting phase hair follicles fall out and a new hair starts. The most important structure of a hair follicle is the dermal papilla, which is responsible for hair growth. The cell of this dermal papilla divides and differentiates to form a new hair follicle. As this dermal papilla lies in direct contact with blood capillaries of the skin, it is responsible for deriving nutrients for hair follicle growth. This dermal papilla has many receptors for androgens; where men have more androgen receptors here than women. The term „common baldness“ usually means male balding pattern baldness (MBP), or permanent-pattern baldness. MPBP is the most common cause of hair loss in men. Men who have this type of hair loss typically also have an inherited or genetic trait as a cause of MBP. Men who start losing their hair at an early age tend to develop more extensive baldness. In MBP, hair loss typically results in a receding hairline and baldness on the top of the head. Testosterone plays an important role in hair loss. When combined with another enzyme in the hair follicle, 5 alpha reductase, testosterone converts to Dihydrotestosterone (DHT). This hormone is a natural metabolite of the human body and is a very potent androgen belonging to the class of compounds called androgenic hormones. The hair follicle when exposed to long periods of DHT eventually miniaturizes and dies.“
Dr. Williams explains, „For many women their hair is a defining physical attribute that defines character and personality. Hair loss affects one’s self image and emotional well-being. It is a very real and serious aesthetic concern for many women, and in 2008 over 15 percent of patients having hair restoration surgical procedures were women. But what exactly causes a woman to lose her hair? To understand that, it’s important to know a basic understanding about hair growth. Women typically experience some degree of hair loss in their lifetime, which can begin in their early twenties. Female Pattern Hair Loss (FPHL) accounts for more than 95% of hair loss in women. The causes of FPHL in women are varied and more complex. In some patients with a genetic predisposition to hair loss, a group of hormones called androgens interferes with the growth cycle of the hair. These androgen hormones-testosterone, Androstenedione, and Dihydrotestosterone (DHT)- are dominant hormones in men, but are present in women to a lesser degree. In many women, hair loss is due to the action of androgens on the hair follicles. In women who are genetically susceptible, when the testosterone comes in contact with enzymes residing in the hair cell, it is converted into the more potent androgen DHT, which then binds with receptors deep within the hair follicle. Over time, DHT in the hair follicle alters the natural resting and growth phases of the hair. Some of the hair follicles eventually die, while others stop continuing healthy hair growth.
The term ‚androgenic alopecia‘ in women is often referred to ‚female pattern hair loss.‘ It is a broader term that encompasses many possible causes of hair loss in women. Androgenic alopecia is caused by factors related to the actions of hormones, e.g., ovarian cysts, use of high androgen index birth control pills, pregnancy, and menopause. Just like in men, DHT and heredity plays a major factor in this disease. In men, the pattern of hair loss is distinct whereas, women have a diffuse thinning of their hair. Female pattern balding affects circumferentially the whole top of the head. Men rarely have diffuse thinning and compared to the hair loss pattern of men, it is entirely different because men tend to lose it on the temple, the crown, and the bald spot in the back. The science of female balding remains misunderstood and we don’t understand all the genetic codes and other factors that play a role in hair loss in women. There are most likely other types of enzymes, as well as hormone receptors and blockers that have yet to be discovered.“
Dr. Williams shares other reasons why women experience hair loss.
„Other medical conditions such as thyroid disorders, polycystic ovary syndrome, anemia, chronic illness, or the use of certain medications can cause hair loss in women. Certain types of autoimmune disorders result in a slightly different and often less dramatic hair loss problem known as alopecia areata — an inflammatory condition that causes hair to come out in clumps or patches.
Accelerated hair loss and thinning is common in women during menopause and perimenopause secondary to changing hormone levels. When estrogen and testosterone levels change during this time period, the imbalance causes hair thinning. Hair loss can be from nutritional deficiency of vitamins A and D, iron and other essential nutrients.
Another type of hair loss in women is called Telogen Effluvium. This is described as a temporary hair loss that follows childbirth, crash dieting, surgery, or a traumatic emotional event. Telogen Effluvium can begin about six (6) weeks to three (3) months after a stressful or traumatic event. It is not uncommon for hair to come out in ‚large clumps‘
Anagen Effluvium is another type of hair loss caused by factors impairing the metabolic activity of the hair follicle. This type of hair loss is associated with chemotherapy because of the toxic effect of the chemotherapy that is designed to stop the cancer cells from growing and dividing. Unfortunately, chemotherapy is not selective and it negatively impacts all cells-healthy and cancerous- including hair follicles in the body.
Traction Alopecia is a type of hair loss that occurs when the hair follicles are traumatized by hair being pulled tight by hairstyles. Braiding, cornrows, tight ponytails, and hair extensions often cause this type of alopecia.
Oral contraceptives can be a cause of hair loss in women who are predisposed to hormonal related hair loss. Hair loss can occur during or after the use of oral contraceptives. It is important to note that any medication or therapy that alters a woman’s hormones, including but not limited to, contraceptives, can trigger hair loss.
This is why women who have a genetic or family history of hair loss need to be aware that the use of oral contraceptives can negatively impact the hair growth cycle resulting in hair loss. If there is a family history of hair loss it is recommended that you use birth control pills that have the lowest androgen index.
Seasonal Hair Loss and Growth
The change in seasons can impact our daily lives, including hair quality, growth and cycle. It is common that we may shed up to 100 hair follicles per day. In some patients, certain seasons were anecdotally associated with more hair loss than others. While we all experience some amount of daily hair shedding, you might start noticing that you are shedding more than usual during the summer months. Summertime hair loss is real, and research suggests that women experience elevated rates of hair shedding due to hair follicles entering a resting phase, known as Telogen Effluvium (TE). When hair is subjected to more extreme weather, perhaps as much as 70 percent of hair follicles can prematurely enter this resting phase, leading to more hair shedding than usual. This may explain why many women experience greater hair loss in July and August when the temperature really heats up outside.“
According to Dr. Williams, „To understand hair loss, it is important to know the cycle of the hair follicle. Hair follicles are not always in the active growth stage. A hair follicle cycles through a growth (Anagen) phase that can last two to seven years, then the hair follicle transitions to a regressing (Catagen) phase lasting a couple of weeks. Afterwards, the hair follicle enters the last and final phase (Telogen) for up to two to four months. The hair follicle then is shed when the hair follicle root re enters a new growth cycle. At any time on a healthy human scalp, about 80% to 90% of the hair follicles are growing hair. That leaves up to 10% to 20% percent of scalp hair follicles in a resting state. Telogen effluvium (TE) is probably the second most common form of hair loss. Generally speaking, TE occurs when there is a change in the number of hair follicles currently growing. If the number of hair follicles producing hair significantly decreases for any reason during the resting (telogen) phase, there will be a significant increase in dormant hair follicles. This is known as TE hair loss. TE hair loss can be more severe in some areas of the scalp than others. It is uncommon to have hairline recession with TE hair loss, except in a few rare chronic cases. The hairs that begin to shed are typically telogen hairs, which can be identified by a small bulb of keratin on the root end. People with TE never completely lose all their hair, but the hair can be noticeably thin in severe cases. TE is often limited to the scalp and is reversible. The hair follicles are not permanently or irreversibly affected, there are just more hair follicles in a resting state than there should normally be. Environmental conditions, stress, diet, acute or chronic illness, nutritional deficiencies, scalp infections and scarring can also cause hair loss, but these are not clinically related to seasonal changes. Because ’summer is coming,‘ you might find your hair density is less during the summer season, but don’t fret, the seasons will change.“